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HSI Tip Form

OMB Control Number: 1653-0049
Expiration Date: 09/30/2014

U.S. Immigration and Customs Enforcement (ICE) investigates more than 400 violations of criminal law, ranging from child exploitation to transnational gangs. Use this form to report suspected criminal activity.

Be as specific and as detailed as possible. You are encouraged to provide any additional identifying details such as places of birth, countries of citizenship, and social security numbers in the below narrative text box. The detailed information you provide will assist investigators as they look into reported violations.

We do not provide status updates for tip information provided. If you provide information, you can be assured that it will be promptly forwarded to the responsible office for follow up action as deemed appropriate.

Do NOT send the same information more than once, and do NOT file a duplicate report by calling the HSI Tip Line.

Although there is absolutely no guarantee that tip information provided will result in monetary payments, ICE has the discretion and statutory authorization to pay for information and/or evidence that is used in support of criminal investigations.

Anonymous tips may be reported on this form and may also be reported to ICE via the toll-free HSI Tip Line, (866) 347-2423.

* = Required Fields

I. Your information

First name:	Last name:
Email:	Phone number:

Are you reporting from:

Inside the U.S.?

Outside of the U.S.?

Street address:
(line 1)
(line 2)

City:

State:

Zip code:

Street address:
(line 1)
(line 2)

City/Province:

Country:

Zip code:

II. Violator information

* Suspected Violation

Please check all that apply.
	Terrorism Related		Weapons Smuggling		Narcotics Smuggling
	Bulk Cash Smuggling/Financial Crimes		Trade Exportation Violation		Trade Importation Violation
	Intellectual Property Rights		Child Exploitation/Pornography		Human Trafficking (Forced Labor/Slavery)
	Human Smuggling		Benefit/Marriage Fraud		Employment/Exploitation of Unlawful Workers
	Gang Related		Fugitive Criminal Alien		Other

If "Other", please explain:

* This complaint involves a:

Business/Company

Individual

Both

Information about business/company

Business/Company name:

Street address:
(line 1)
(line 2)

City:

State:

Zip code:

Information about the individual

First name:

Last name:

Date of birth:
Month	Day	Year	Approximate age:

Street address:
(line 1)
(line 2)

City:

State:

Zip code:

III. Violations

Location of Criminal Activity (if known)

Street address:
(line 1)
(line 2)

City:

State:

Zip code:

* Have you previously submitted this information to any law enforcement or government agency?

Yes

No

* If yes, provide the date, name of agency and other details in the narrative text box below. (limit 200 characters).
You have characters left.

* Please provide a summary of the criminal activity (limit 2,500 characters).
You have characters left.

* Did you have additional businesses/individuals to report on?

Yes

No

If you have additional businesses/individuals to report on, please complete another form after you submit this completed form. Thank you.

PRIVACY ACT NOTICE/PAPERWORK REDUCTION ACT NOTICE

Authority: 6 U.S.C. § 203; 8 U.S.C. § 1103; 8 U.S.C. § 1357; 8 U.S.C. § 1360; 19 U.S.C. § 1589a; 5 U.S.C. § 552a; 5 U.S.C. § 301; and 44 U.S.C. § 3101 authorize ICE to collect your information requested in this web form. Please also see the privacy policy for ICE's public website available at http://www.ice.gov/about/legal.htm for additional information about the type of information that is collected about you when you visit this and other pages on the ICE.gov website.

Purpose(s): The information requested is being collected to initiate and/or support a law enforcement investigation. ICE may also use your information to contact you for additional details about your tip, or to arrange monetary payment, if applicable.

Routine Use(s): Your information and the information you provide in your tip regarding suspicious or suspected criminal activity and/or violation of law may be shared internally within to the Department of Homeland Security (DHS) for any appropriate law enforcement action. The information you provide may also be shared with other federal, state, local, tribal or foreign agencies in order to refer reports of suspicious activity, tips, potential violations of law and other relevant information to those agencies with appropriate jurisdiction, authorities, and/or need-to-know concerning the matter(s) you report. The information you provide may also be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended, pursuant to the routine uses published in the Department of Homeland Security system of records notice, DHS/ICE-007 Alien Criminal Response Information Management.

Disclosure: In order to submit a tip using this web form, the disclosure of your contact information in this web form is voluntary. Should you wish to submit an anonymous tip via phone, you may call the HSI Tip Line at (866) 347-2423.

Public Reporting Burden: U.S. Immigration and Customs Enforcement is collecting this information as a part of its agency mission under the Department of Homeland Security. The estimated average time to review the instructions, search existing data sources, gather and maintain the data needed and completing and reviewing this collection of information is 10 minutes (0.166 hours) per response. An agency may not conduct or sponsor, and a person is not required to respond to, an information collection unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Office of the Chief Financial Officer/OAA/Records Branch, US Immigration and Customs Enforcement 500 12th ST SW, STOP 5705, Washington, D.C. 20536-5705.

WARNING REGARDING KNOWINGLY PROVIDING FALSE INFORMATION

The information I've provided on this form is correct to the best of my knowledge. I understand that providing false information could subject me to fine, imprisonment, or both. (Title 18, U.S.C. § 1001).